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coronary microvascular dysfunction

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https://www.readbyqxmd.com/read/29154426/microvascular-dysfunction-and-cardiac-fibrosis-in-heart-failure-with-preserved-ejection-fraction-a-case-report
#1
Nikhil Narang, Diego Medvedofsky, Kathryn Dryer, Sanjiv J Shah, Charles J Davidson, Amit R Patel, John E A Blair
We report the case of a 55-year-old woman with heart failure with preserved ejection fraction (HFpEF), who presented with hypertensive urgency and pulmonary oedema. The patient was medically optimized and underwent cardiac catheterization revealing pulmonary hypertension, elevated pulmonary capillary wedge pressure, normal cardiac index, and non-obstructive coronary disease. Invasive evaluation of coronary flow revealed blunted coronary flow reserve and increased index of microvascular resistance. Cardiac magnetic resonance imaging demonstrated reduced global myocardial perfusion and diffuse interstitial fibrosis...
November 2017: ESC Heart Failure
https://www.readbyqxmd.com/read/29146670/three-vessel-assessment-of-coronary-microvascular-dysfunction-in-patients-with-clinical-suspicion-of-ischemia-prospective-observational-study-with-the-index-of-microcirculatory-resistance
#2
Yuhei Kobayashi, Joo Myung Lee, William F Fearon, Jang Hoon Lee, Takeshi Nishi, Dong-Hyun Choi, Frederik M Zimmermann, Ji-Hyun Jung, Hyun-Jung Lee, Joon-Hyung Doh, Chang-Wook Nam, Eun-Seok Shin, Bon-Kwon Koo
BACKGROUND: Difficulty directly visualizing the coronary microvasculature as opposed to the epicardial coronary artery makes its assessment challenging. The goal of this study is to measure the index of microcirculatory resistance (IMR) in all 3 major coronary vessels to identify the clinical and angiographic predictors of an abnormal IMR. METHODS AND RESULTS: Ninety-three patients who underwent coronary physiological assessment in all 3 major coronary vessels were prospectively enrolled (59...
November 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29132649/doppler-versus-thermodilution-derived-coronary-microvascular-resistance-to-predict-coronary-microvascular-dysfunction-in-patients-with-acute-myocardial-infarction-or-stable-angina-pectoris
#3
Rupert P Williams, Guus A de Waard, Kalpa De Silva, Matthew Lumley, Kaleab Asrress, Satpal Arri, Howard Ellis, Awais Mir, Brian Clapp, Amedeo Chiribiri, Sven Plein, Paul F Teunissen, Maurits R Hollander, Michael Marber, Simon Redwood, Niels van Royen, Divaka Perera
Coronary microvascular resistance is increasingly measured as a predictor of clinical outcomes, but there is no accepted gold-standard measurement. We compared the diagnostic accuracy of 2 invasive indices of microvascular resistance, Doppler-derived hyperemic microvascular resistance (hMR) and thermodilution-derived index of microcirculatory resistance (IMR), at predicting microvascular dysfunction. A total of 54 patients (61 ± 10 years) who underwent cardiac catheterization for stable coronary artery disease (n = 10) or acute myocardial infarction (n = 44) had simultaneous intracoronary pressure, Doppler flow velocity and thermodilution flow data acquired from 74 unobstructed vessels, at rest and during hyperemia...
October 10, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/29130567/treatment-strategies-in-coronary-microvascular-dysfunction-a-systematic-review-of-interventional-studies
#4
Hannah E Suhrs, Marie M Michelsen, Eva Prescott
Coronary microvascular dysfunction has been associated with a wide spectrum of diseases and conditions, and it has proven to be a strong prognostic marker of morbidity and mortality. Despite increased attention guideline-based treatment recommendations are lacking. We performed a systematic review of pharmacological and non-pharmacological interventions to improve coronary perfusion, assessed by intracoronary Doppler, transthoracic Doppler echocardiography, positron emission tomography, cardiac magnetic resonance imaging, transthoracic contrast perfusion echocardiography and dilution techniques...
November 11, 2017: Microcirculation: the Official Journal of the Microcirculatory Society, Inc
https://www.readbyqxmd.com/read/29106832/-diabetes-mellitus-a-prothrombotic-disease
#5
F Picard, J Adjedj, O Varenne
In patients with acute atherothrombotic disease, diabetes or glucose intolerance is frequently found. Indeed, the number of people with diabetes in the world continues to increase and is expected to reach more than 500 million people by 2035. Diabetes is a pathology commonly associated with both microvascular and macrovascular complications. Although the mortality of coronary artery disease has decreased significantly over the past 20 years, mortality in patients with type 2 diabetes has changed little and atherothrombotic events remain the leading cause of death in diabetic patients...
October 26, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/29096805/sex-related-differences-in-vasomotor-function-in-patients-with-angina-and%C3%A2-unobstructed-coronary-arteries
#6
Ahmed Aziz, Henrik Steen Hansen, Udo Sechtem, Eva Prescott, Peter Ong
BACKGROUND: Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. OBJECTIVES: The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). METHODS: Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm...
November 7, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29096622/tissue-engineered-smooth-muscle-cell-and-endothelial-progenitor-cell-bi-level-cell-sheets-prevent-progression-of-cardiac-dysfunction-microvascular-dysfunction-and-interstitial-fibrosis-in-a-rodent-model-of-type-1-diabetes-induced-cardiomyopathy
#7
Masashi Kawamura, Michael J Paulsen, Andrew B Goldstone, Yasuhiro Shudo, Hanjay Wang, Amanda N Steele, Lyndsay M Stapleton, Bryan B Edwards, Anahita Eskandari, Vi N Truong, Kevin J Jaatinen, Arnar B Ingason, Shigeru Miyagawa, Yoshiki Sawa, Y Joseph Woo
BACKGROUND: Diabetes mellitus is a risk factor for coronary artery disease and diabetic cardiomyopathy, and adversely impacts outcomes following coronary artery bypass grafting. Current treatments focus on macro-revascularization and neglect the microvascular disease typical of diabetes mellitus-induced cardiomyopathy (DMCM). We hypothesized that engineered smooth muscle cell (SMC)-endothelial progenitor cell (EPC) bi-level cell sheets could improve ventricular dysfunction in DMCM. METHODS: Primary mesenchymal stem cells (MSCs) and EPCs were isolated from the bone marrow of Wistar rats, and MSCs were differentiated into SMCs by culturing on a fibronectin-coated dish...
November 2, 2017: Cardiovascular Diabetology
https://www.readbyqxmd.com/read/29081724/role-of-stress-cardiac-magnetic-resonance-imaging-in-women-with-suspected-ischemia-but-no-obstructive-coronary-artery-disease
#8
Sawan Jalnapurkar, Parham Zarrini, Puja K Mehta, Louise E J Thomson, Megha Agarwal, Bruce A Samuels, Chrisandra L Shufelt, Jo-Ann Eastwood, Daniel Berman, Noel Bairey Merz, Margo B Minissian
OBJECTIVE: Signs and symptoms of ischemia but no obstructive coronary artery disease (CAD) is often a diagnostic dilemma in women. The use of stress cardiac magnetic resonance imaging (CMRI) for advanced diagnostic assessment in these patients is a non-ionizing radiation option, but the diagnostic utility in this population is unknown. We examined the diagnostic role of stress CMRI in our patient population of these women. METHODS: We analyzed 113 consecutive female patients from 2/2006-11/2007 who had prior cardiac evaluations for signs and symptoms of ischemia but no obstructive CAD who underwent stress CMRI, which included anatomic, functional, adenosine stress perfusion and delayed enhancement imaging...
September 2017: Journal of Radiology Nursing
https://www.readbyqxmd.com/read/29080583/prediabetes-beyond-the-borderline
#9
REVIEW
Mara Lynn Wilson
Prediabetes is a complex multifactorial metabolic disorder that extends beyond glucose control. Current studies have found that microvascular disease (neuropathy, nephropathy, and retinopathy), macrovascular disease (stroke, coronary artery disease, and peripheral vascular disease), periodontal disease, cognitive dysfunction, blood pressure changes, obstructive sleep apnea, low testosterone level, fatty liver disease, and cancer are some of conditions that are present with the onset of glycemic dysregulation...
December 2017: Nursing Clinics of North America
https://www.readbyqxmd.com/read/29073603/vascular-endothelial-dysfunction-during-cardiac-surgery-on-pump-versus-off-pump-coronary-surgery
#10
Florian Brettner, Daniel Chappell, Lisa Schwartz, Alexander Lukasz, Philipp Kümpers, Bernhard F Becker, Bruno Reichart, Markus Rehm, Dirk Bruegger
BACKGROUND: Cardiac surgery often causes ischemia and development of a systemic inflammatory response syndrome, which impairs vascular barrier function, normally maintained by the endothelial cell line and the endothelial glycocalyx (EG). The EG normally covers and protects healthy endothelial cells throughout the vasculature. The aim of the present study was to assess the disruption of the cellular part of the microvascular barrier by determining parameters of endothelial cell activation known to influence and reflect cell-cell junctional integrity...
October 26, 2017: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
https://www.readbyqxmd.com/read/29070069/adenosine-stress-cmr-t1-mapping-detects-early-microvascular-dysfunction-in-patients-with-type-2-diabetes-mellitus-without-obstructive-coronary-artery-disease
#11
Eylem Levelt, Stefan K Piechnik, Alexander Liu, Rohan S Wijesurendra, Masliza Mahmod, Rina Ariga, Jane M Francis, Andreas Greiser, Kieran Clarke, Stefan Neubauer, Vanessa M Ferreira, Theodoros D Karamitsos
BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with coronary microvascular dysfunction in the absence of obstructive coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) T1-mapping at rest and during adenosine stress can assess coronary vascular reactivity. We hypothesised that the non-contrast T1 response to vasodilator stress will be altered in patients with T2DM without CAD compared to controls due to coronary microvascular dysfunction. METHODS: Thirty-one patients with T2DM and sixteen matched healthy controls underwent CMR (3 T) for cine, rest and adenosine stress non-contrast T1-mapping (ShMOLLI), first-pass perfusion and late gadolinium enhancement (LGE) imaging...
October 25, 2017: Journal of Cardiovascular Magnetic Resonance
https://www.readbyqxmd.com/read/29069202/association-of-inflammation-and-endothelial-dysfunction-with-coronary-microvascular-resistance-in-patients-with-cardiac-syndrome-x
#12
Ming Long, Zhibin Huang, Xiaodong Zhuang, Zena Huang, Yue Guo, Xinxue Liao, Chufan Luo
BACKGROUND: Although a proportion of CSX patients have impaired brachial artery flow-mediated dilatation (FMD) in response to hyperemia, suggesting that endothelial dysfunction in these patients may be systemic and not just confined to the coronary circulation; the underlying mechanisms triggering endothelial dysfunction in these patients are still incompletely understood. OBJECTIVES: To assess the association of the index of Microcirculatory Resistance (IMR) with endothelial dysfunction and inflammation in patients with CSX...
October 19, 2017: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29051079/reduced-myocardial-flow-reserve-is-associated-with-diastolic-dysfunction-and-decreased-left-atrial-strain-in-patients-with-normal-ejection-fraction-and-epicardial-perfusion
#13
Matthew C Konerman, Joshua C Greenberg, Theodore J Kolias, James R Corbett, Ravi V Shah, Venkatesh L Murthy, Scott L Hummel
INTRODUCTION: Coronary microvascular dysfunction (MVD) may contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Speckle-tracking echocardiography is a feasible and reproducible method for identifying abnormalities in left ventricular (LV) and left atrial (LA) function among HFpEF patients. By assessing myocardial flow reserve (MFR), positron emission tomography (PET) imaging enables quantitative assessment of coronary MVD. We hypothesized that, in patients with risk factors for HFpEF and normal epicardial perfusion on cardiac PET, abnormal MFR is associated with LV diastolic dysfunction (DD) and reduced LV and LA strain...
October 16, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/29046002/-optimal-diagnostics-and-therapy-for-microvascular-angina-pectoris
#14
Peter Ong, Udo Sechtem
Patients with microvascular angina are characterized by angina pectoris with proof of myocardial ischemia in the absence of any relevant epicardial stenosis and without myocardial disease (type 1 coronary microvascular dysfunction according to Crea and Camici). Structural and functional alterations of the coronary microvessels (diameter < 500 µm) are the reason for this phenomenon. Frequently such alterations are associated with cardiovascular risk factors. Patients with angina pectoris without epicardial stenoses represent for 10 - 50 % of all patients undergoing coronary angiography depending on the clinical presentation...
October 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/29033166/early-peripheral-endothelial-dysfunction-predicts-myocardial-infarct-extension-and-microvascular-obstruction-in-patients-with-st-elevation-myocardial-infarction
#15
Sérgio Bravo Baptista, Mariana Faustino, Luís Brizida, José Loureiro, João Augusto, João Abecasis, Célia Monteiro, Paulo Leal, Maura Nédio, Pedro Farto E Abreu, Victor Gil, Carlos Morais
INTRODUCTION AND OBJECTIVES: The role of endothelial dysfunction (ED) in patients with ST-elevation myocardial infarction (STEMI) is poorly understood. Peripheral arterial tonometry (PAT) allows non-invasive evaluation of ED, but has never been used for this purpose early after primary percutaneous coronary intervention (P-PCI). Our purpose was to analyze the relation between ED assessed by PAT and both the presence of microvascular obstruction (MVO) and infarct extension in STEMI patients...
October 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29032954/coronary-flow-reserve-is-predictive-of-the-risk-of-cardiovascular-death-regardless-of-chronic-kidney-disease-stage
#16
David M Charytan, Hicham Skali, Nishant R Shah, Vikas Veeranna, Michael K Cheezum, Viviany R Taqueti, Takashi Kato, Courtney R Bibbo, Jon Hainer, Sharmila Dorbala, Ron Blankstein, Marcelo F Di Carli
Microvascular rarefaction is found in experimental uremia, but data from patients with chronic kidney disease (CKD) are limited. We therefore quantified absolute myocardial blood flow and coronary flow reserve (the ratio of peak to resting flow) from myocardial perfusion positron emission tomography scans at a single institution. Individuals were classified into standard CKD categories based on the estimated glomerular filtration rate. Associations of coronary flow reserve with CKD stage and cardiovascular mortality were analyzed in models adjusted for cardiovascular risk factors...
October 13, 2017: Kidney International
https://www.readbyqxmd.com/read/29031990/international-standardization-of-diagnostic-criteria-for-microvascular-angina
#17
Peter Ong, Paolo G Camici, John F Beltrame, Filippo Crea, Hiroaki Shimokawa, Udo Sechtem, Juan Carlos Kaski, C Noel Bairey Merz
Standardization of diagnostic criteria for ischemic symptoms due to coronary microvascular dysfunction (CMD) is needed for further investigation of patients presenting with anginal chest pain consistent with "microvascular angina" (MVA). At the annual Coronary Vasomotion Disorders International Study Group (COVADIS) Summits held in August 2014 and 2015, the following criteria were agreed upon for the investigative diagnosis of microvascular angina: (1) presence of symptoms suggestive of myocardial ischemia; (2) objective documentation of myocardial ischemia, as assessed by currently available techniques; (3) absence of obstructive CAD (<50% coronary diameter reduction and/or fractional flow reserve (FFR) >0...
September 8, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29030424/stable-coronary-syndromes-pathophysiology-diagnostic-advances-and-therapeutic-need
#18
REVIEW
Thomas J Ford, David Corcoran, Colin Berry
The diagnostic management of patients with angina pectoris typically centres on the detection of obstructive epicardial CAD, which aligns with evidence-based treatment options that include medical therapy and myocardial revascularisation. This clinical paradigm fails to account for the considerable proportion (approximately one-third) of patients with angina in whom obstructive CAD is excluded. This common scenario presents a diagnostic conundrum whereby angina occurs but there is no obstructive CAD (ischaemia and no obstructive coronary artery disease-INOCA)...
October 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29025901/effects-of-age-and-exercise-training-on-coronary-microvascular-smooth-muscle-phenotype-and-function
#19
Judy M Muller-Delp, Kazuki Hotta, Bei Chen, Bradley Jon Behnke, Joshua J Maraj, Michael D Delp, Tiffani R Lucero, Jeremy A Bramy, David B Alarcon, Hannah E Morgan, Morgan R Cowan, Anthony D Haynes
Coronary microvascular function and blood flow responses during acute exercise are impaired in the aged heart, but can be restored by exercise training. Coronary microvascular resistance is directly dependent on vascular smooth muscle function in coronary resistance arterioles; therefore, we hypothesized that age impairs contractile function and alters the phenotype of vascular smooth muscle in coronary arterioles. We further hypothesized that exercise training restores contractile function and reverses age-induced phenotypic alterations of arteriolar smooth muscle...
October 12, 2017: Journal of Applied Physiology
https://www.readbyqxmd.com/read/28990847/obstructive-sleep-apnoea-from-respiratory-events-to-coronary-microvascular-dysfunction
#20
Sofia Morra, François Roubille
Obstructive sleep apnoea (OSA) is an emerging and independent risk factor for cardiovascular diseases; coronary artery disease (CAD) is higher in OSA patients, even in the absence of other traditional cardiovascular risk factors. There is little evidence to show abnormalities in coronary blood flow (CBF) and disorders in coronary vascular resistance (CVR), occurring during the obstructive respiratory event, suggesting coronary microvascular dysfunction (CMD) as a potential mechanism of ischaemic heart disease (IHD) OSA-as a related consequence...
October 9, 2017: Acta Cardiologica
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